DRUG ADDICTION PROGRAMMES

Sir, - Mr Andre Lyder (February 26th) refers to the Merchant's Quay
Project's recently published report "Making Contact - An Evaluation of a
Syringe Exchange", and questions the impact of these types of programmes in
reducing drug related harm. He cites the greater incidence of HIV infection
amongst drug users in Holland (which has well developed syringe exchange
services) compared to the lower levels of infection in Ireland (where
syringe exchange services are patchy and underdeveloped) as an argument
against syringe exchange services, but, as he points out later in his
letter, the longer the injecting career, the greater the risk.

Irish drug users are the youngest in the EU, with an average age of just
24. The average age of Dutch drug users is 35 and most began using drugs,
and contracted HIV, prior to the introduction of syringe exchange services
in the Netherlands. Considering that Holland has an estimated 25,000 opiate
users in a population of 15 million and Ireland has 13,000 opiate users for
a population of just over 3.5 million, it might be fair to say that there
is much we can learn from Dutch drugs policy, which is primarily focussed
on reducing drug-related harm. Syringe exchange and other harm reduction
services are less common in Ireland. Where they are in place, as at the
Merchant's Quay Project, the evidence for the effectiveness of this
approach is strong.

The Merchant's Quay Project evaluation was the first of its kind carried
out in the Irish context. It looked at the infection risk behaviour of
injecting drug users attending the Project's Health Promotion Unit (which
offers a syringe exchange service) for the first time, and again after
three months.

Significant reductions in risk behaviour took place over the three-month
period. Almost three-quarters of the sample had stopped, or significantly
reduced their incidence of sharing injecting equipment. More than two
thirds had reduced their frequency of injecting heroin. Eleven per cent had
stopped injecting heroin altogether.

In addition, there were a variety of other positive outcomes in relation to
health and well being, including increased contact with medical services, a
reduction in the incidence of overdosing, a reduction in experience of
abscesses and improvements in psychological functioning.

We share Mr Lyder's concern about the high prevalence of Hepatitis C
infection among drug users which is much more virulent than HIV, and can be
transmitted through sharing injecting paraphernalia including spoons and
filters. In the past, syringe exchange programmes have concentrated on HIV
awareness and our research showed that drug users were not sufficiently
aware of the risk of Hepatitis C infection, and had not altered their
behaviour in this regard. To remedy this, the report recommended an
awareness campaign aimed at drug users identifying the dangers involved in
sharing such materials. Staff at the Project syringe exchange are now
placing increased emphasis on these risks in their interventions with drug
users.

Ireland has the highest number of drug related deaths (mainly through
overdose) in the EU and the number has increased throughout the 1990s. Drug
related deaths have stabilised or declined in most other EU countries.
Syringe exchange programmes are designed to reduce risk of infection and
risk of overdose through the provision of clean injecting equipment and
clear information on safer drug use. The absence of comprehensive harm
reduction services in Dublin means that we suffer more drug related harm
than do most of our European neighbours.

We agree that tackling addiction is an important aspect of any relevant
drugs policy. However, as Dr Joe Barry, specialist in public health
medicine at Baggot Street Hospital, has stated, 95 per cent of drug users
are unwilling or unable to tackle their addiction. It is of great
importance that we work in a pragmatic way with drug users to reduce
injecting related risk amongst this vulnerable group. Syringe exchange
services are essential to this.

- - Yours, etc.

Tony Geoghegan,
Director,
Merchant's Quay Project,
Dublin 2.